A Clinical Trial from the inside

A Clinical Trial from the inside
Julia Greenland

It’s an exciting time in the Williams-Gray Parkinson’s disease research group! We are finally opening our clinical trial of azathioprine in PD (AZA-PD). It’s been a long road, which has involved lots of delays (to say nothing of the pandemic), but yesterday I sent out the first 8 invitation letters. I now have my fingers crossed, hoping for some eager participants!

The group has been researching the immune system in PD for a number of years now, and has found several clues that imply it is involved in causing PD to progress. And even that it may help to answer the question of why some people might get Parkinson’s disease in the first place. Our work fits in with what people all round the world are also finding; that the immune system seems unusually active and primed to respond to some of the disease-related changes, such as the accumulation of alpha-synuclein in dopamine producing cells in the brain. Despite the weight of evidence pointing towards its involvement, the only way to tell for sure if changing the immune system can slow down PD is by running a clinical trial and testing an immune medication as a treatment in patients. This is not something that can be proved with experiments in the lab. The medication that Caroline (Dr Williams-Gray) chose is one that is well known to doctors. It is called azathioprine and dampens down the immune system. Although it has side effects (there isn’t a tablet without them), we know what the problems are, how to spot them early and what to do to sort them out.

My involvement in this trial started in late 2017. I had just had a baby and come back to work as a neurology registrar in Addenbrookes hospital in Cambridge. As part of my training to become a neurology consultant, I was planning on embarking on a PhD. I’d previously done a small amount of research in PD in Newcastle whilst I was a medical student, and I’d emailed Prof Roger Barker looking for a clinical project that I could get involved in. He put me in touch with Caroline. It feels like I’ve had a long road to get here, but Caroline’s is much longer. By the time I came on-board she had come up with the concept, designed the trial and successfully secured funding through the Centre for Parkinson’s Plus. (Naively) at that point it felt that the majority of the large hurdles were cleared. I started at the John van Geest Centre for Brain Repair in January 2018, working on writing the protocol and associated documents that accompany the running of a clinical trial, and preparing the application for the Research Ethics Committee. We thought we would be recruiting patients by the end of that year…

It’s year three, another baby and one pandemic later. But we are here. On the brink of welcoming our first participants to AZA-PD. (Fingers crossed for no further hiccups!).

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